| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
716 |
705 |
$17K |
| D1110 |
Prophylaxis - adult |
386 |
377 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
426 |
401 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
340 |
337 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
102 |
101 |
$3K |
| D0330 |
Panoramic radiographic image |
43 |
42 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
63 |
$2K |